The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Randomized Controlled Trial Clinical Trial
Pupil examination: validity and clinical utility of an automated pupillometer.
Pupillary size and reactivity have long been a critical component of the clinical assessment of patients with neurological disorders. The pupillary examination may provide critical information related to new or worsening intracranial pathology and facilitate prompt intervention to minimize further neuronal damage. With this in mind, intensive care nurses caring for neurologically impaired patients frequently must perform pupillary examinations in concert with assigning a Glasgow Coma Scale score. ⋯ Measurements by a static pupillometer before and after each pupillary examination were used to determine the mean "true" size of the pupil. This study found that the automated pupillometer is more accurate and reliable than the manual examination in measuring pupil size and reactivity. For these reasons, such a device may be a beneficial addition in the clinical assessment of neurologically impaired patients.
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Monitoring methods following severe head injury currently use indirect measurements of cerebral oxygenation and perfusion defined as intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring. Adequate information regarding cerebral blood flow and oxygenation is necessary to guide treatment and prevent secondary cerebral ischemia. Because of the ineffectiveness of ICP and CPP monitoring in detecting early ischemic changes in healthy, as well as compromised, brain tissue, patients' neurological outcome and recovery may be less than optimal. ⋯ This unique combination helps reflect early changes in brain tissue viability. As with any new monitoring device, there are associated advantages and disadvantages as well as cost issues, to consider. Patients with head injuries can benefit from technology that guides decisions and prevents treatment delays.
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Intrathecal baclofen (ITB) therapy has evolved into a standard treatment for severe spasticity. After this therapy had been provided for 10 years, a retrospective chart review on 50 patients, representing a total 2,922 patient months of ITB service, was done. ⋯ Pump refills occurred every 3 months for 58% of the group. Three evolving trends in ITB therapy were identified from clinical trial to current management: (a) higher catheter tip placement, (b) use of more complex infusion modes, and (c) a decreased complication rate.
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Young onset Parkinson's disease (YOPD) is defined as idiopathic Parkinson's disease (IPPD) occurring in people between 21 and 40 years of age; it strikes approximately 5% of Parkinson's patients. YOPD has earlier onset of motor complications than later onset Parkinson's disease. Motor complications and disease progression are responsible for devastating morbidity. ⋯ This case history documents the course of a YOPD patient with unusually severe motor complications. He is the only patient at Puget Sound Neurology ever to develop rhabdomyolysis due to dyskinesias. Following bilateral subthalamic nucleus deep brain stimulation, his Parkinson's symptoms have improved dramatically, and his motor complications are significantly improved.
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Children with cerebral palsy (CP) face many challenges including impaired motor control and coordination, functional impairment, sensory disturbances, and, sometimes, communication difficulties and cognitive deficits. Pain also may be a problem for children with CP due in part to the inherent deficits associated with the disease, as well as the invasive medical and surgical procedures and rehabilitative activities children with CP undergo on a regular basis. A review of current literature indicates pain is a common experience for children with CP and has been understudied in this population. Further emphasis and research on appropriate assessment and management strategies sensitive to the unique characteristics and limitations of children with CP are warranted.